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Mustfar SNS, Haroon R, Abd Aziz A. The Nomadic Bug: A Case Report of Salmonella Septic Arthritis of Sternoclavicular Joint in a Healthy Patient. Cureus 2024; 16:e57685. [PMID: 38707005 PMCID: PMC11070278 DOI: 10.7759/cureus.57685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
In an otherwise healthy adult, septic arthritis of the sternoclavicular joint is very uncommon. Usually, individuals with a history of intravenous drug usage or those with impaired immune systems are affected. The usual mode of spread is hematogenous spread or direct spread via neighbouring sources of infection. We report a rare case of mediastinitis and lung empyema preceded by sternoclavicular septic arthritis in an otherwise healthy 49-year-old woman due to Salmonella sp. Radiological imaging showed left sternoclavicular joint collection with bone destruction. The literature only contained reports of two prior occurrences of sternoclavicular joint septic arthritis caused by Salmonella. If diagnosed early, patients usually respond to medical treatment such as aspiration and antibiotics, as was the case with our patient.
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Affiliation(s)
| | - Raihanah Haroon
- Radiology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| | - Azian Abd Aziz
- Radiology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
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2
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Kodama K, Momozane T, Takehara H, Kaneko M, Honda H. Disseminated Penicillin-Resistant Streptococcus pneumoniae Infection: A Case Report. Cureus 2024; 16:e59225. [PMID: 38680822 PMCID: PMC11056242 DOI: 10.7759/cureus.59225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/01/2024] Open
Abstract
An invasive pneumococcal disease involving sternoclavicular joint arthritis, lumbar spondylodiscitis, and muscular abscesses caused by penicillin-resistant Streptococcus pneumoniae has not been reported previously. We successfully treated a 57-year-old man with this condition using surgical drainage and debridement, and laminectomy/fenestration, in combination with the administration of two IV antimicrobial drugs based on blood culture results. Clinical resolution was obtained after decompression of the lumbar spine, with minimal restriction of the left lower limb. This treatment approach should be considered depending on the pathogen, underlying host factors, and the severity of the disease.
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Affiliation(s)
- Ken Kodama
- Department of Thoracic Surgery, Yao Municipal Hospital, Yao, JPN
| | - Toru Momozane
- Department of Thoracic Surgery, Yao Municipal Hospital, Yao, JPN
| | - Hiroshi Takehara
- Department of Thoracic Surgery, Yao Municipal Hospital, Yao, JPN
| | - Masanori Kaneko
- Department of Orthopedic Surgery, Yao Municipal Hospital, Yao, JPN
| | - Hirotsugu Honda
- Department of Orthopedic Surgery, Yao Municipal Hospital, Yao, JPN
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3
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Yoshimura F, Kubosaki J, Kunitomo K, Tsuji T. Sternoclavicular Septic Arthritis Due to Invasive Pneumococcal Infection After Type A Influenza Virus Infection. Cureus 2023; 15:e38859. [PMID: 37180546 PMCID: PMC10172377 DOI: 10.7759/cureus.38859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 05/16/2023] Open
Abstract
A 24-year-old female patient who had a type A influenza virus infection prior to admission visited our hospital complaining of a fever and right sternoclavicular pain. Blood culture was positive for penicillin-sensitive Streptococcus pneumoniae (pneumococcus). Magnetic resonance imaging of the right sternoclavicular joint (SCJ) showed a high signal intensity area on the diffusion-weighted images. Consequently, the patient was diagnosed with septic arthritis due to invasive pneumococcus. When a patient complains of gradually increasing chest pain after an influenza virus infection, SCJ septic arthritis should be considered in the differential diagnosis.
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Affiliation(s)
- Fumitaka Yoshimura
- Department of General Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, JPN
| | - Junko Kubosaki
- Department of General Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, JPN
| | - Kotaro Kunitomo
- Department of General Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, JPN
| | - Takahiro Tsuji
- Department of General Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, JPN
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Walker JK, Cronin JT, Richards BW, Skedros JG. Acute Sternoclavicular Joint Sepsis With Medial Clavicle Osteomyelitis (Staphylococcus aureus) and Cervical-Thoracic Epidural Phlegmon in an Adult Female With No Apparent Risk Factors. Cureus 2023; 15:e35870. [PMID: 37033534 PMCID: PMC10079283 DOI: 10.7759/cureus.35870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
This is a case of a 71-year-old female with a history of only one known medical problem (hypertension) who presented with a right sternoclavicular joint (SCJ) infection in addition to (1) a contiguous lower cervical and upper thoracic epidural phlegmon and (2) cellulitis and a phlegmon in her posterior neck, which was subcutaneous and near the lower cervical and upper thoracic spinous processes. These loci of infection developed several days after she had pricked her fingers when cutting rose bushes and were initially considered to be epidural abscesses. However, after the patient was transferred to our tertiary medical center, a neurosurgeon and radiologist determined that the cervicothoracic infections were phlegmons rather than fully developed abscesses. The phlegmons were treated with only IV antibiotics. The SCJ infection was surgically debrided, and the medial clavicle was excised. Bone and fluid cultures grew methicillin-sensitive Staphylococcus aureus (S. aureus). The patient recovered uneventfully (the final follow-up was four years later). This case is uncommon because of the concurrent SCJ infection with medial clavicle osteomyelitis, cervical-thoracic epidural, and paraspinous phlegmons.
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Muacevic A, Adler JR, Pacheco L. Bemoan My Collarbone: A Case of Costocondral Junction Syndrome Complicated by Methicillin Sensitive Staphylococcus aureus Sternoclavicular Osteomyelitis and Septic Arthritis. Cureus 2023; 15:e34108. [PMID: 36699106 PMCID: PMC9870702 DOI: 10.7759/cureus.34108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
A 35-year-old female with a past medical history of untreated Hepatitis-C, and a history of intravenous (IV) drug use initially presented to the emergency department with chief complaints of gradual worsening sharp, constant left-sided chest pain with no radiation starting three weeks before presentation. In the emergency department (ED), she was afebrile, normotensive, and tachycardia with 99% oxygen saturation on room air. A physical exam revealed a well-developed Caucasian female, alert and oriented with moderate distress. Respiratory exam with symmetrical bilateral excursions without wheezes, crackles, or rhonchi. On cardiovascular exam, she was tachycardic with a regular rhythm without murmurs, rubs, or gallops. There was a 2 x 2 cm tender erythematous swelling on the left sternal border inferior to the clavicle. The neck was supple and negative for Jugular Venous Distension (JVD). Neurologically grossly intact. Abnormal laboratory findings included leukocytosis with neutrophilic predominance. The patient received intravenous (IV) antibiotics with broad-spectrum vancomycin, cefepime, and azithromycin and underwent computed tomography angiography (CTA) chest, revealing a 26.8 mm x 26.5 mm left anterior subapical pleural-based pulmonary mass-like lesion with central hypoattenuation in surrounding ground-glass changes. Biopsy of the left subapical pulmonary lesion results showed chronic inflammatory infiltrate. Unfortunately, the patient left the hospital against medical advice after supportive care and pain control. Our patient's history of intravenous drug use and active Hepatitis-C infection were typical risk factors associated with invasive infections. In the clinical context, leukocytosis with hypo-attenuated pulmonary lesion should raise suspicion for septic emboli, localized abscess pocket, infection by atypical organisms, infective endocarditis, and malignancy which was considered upon initial assessment.
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Minimally Invasive Surgery for Sternoclavicular Joint Infection with Osteomyelitis, Large Abscesses, and Mediastinitis. Case Rep Surg 2022; 2022:9461619. [PMID: 36317047 PMCID: PMC9617732 DOI: 10.1155/2022/9461619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022] Open
Abstract
Background Sternoclavicular joint infections require en bloc resection for radical cure; however, this aggressive procedure may result in multiple adverse events. Therefore, performing minimally invasive surgery is desirable. In this report, we describe a case of sternoclavicular joint infection complicated by osteomyelitis, large abscesses, and mediastinitis that was successfully treated with incision and drainage. Case Presentation. A 42-year-old man with no medical history presented to our hospital with complaints of painful swelling in the left chest wall and acute dyspnea. Computed tomography revealed arthritis of the left sternoclavicular joint, osteomyelitis of the clavicle and sternum, anterior mediastinitis, and abscesses in the neck, chest wall, and retrosternal and extrapleural spaces. Gram staining of the aspirated pus revealed clusters of gram-positive cocci. A diagnosis of Staphylococcus aureus sternoclavicular joint infection with locoregional spread was made. Emergency surgery was performed following adequate resuscitation. A skin incision was made in the second intercostal space. The joint capsule was widely opened, necrotic tissue was curetted, and closed suction drains were placed in the abscess cavities and connected to a negative pressure system. The wound was then closed using primary sutures. The postoperative course was uneventful. Methicillin-sensitive Staphylococcus aureus was cultured from the pus. The patient was discharged on postoperative day 14. Osteomyelitis worsened within a few weeks after surgery but recovered with wound management and six weeks of antibiotic therapy. The patient has had no recurrence of infection for two years. Conclusions Incision and drainage proved to be an effective minimally invasive surgical treatment for sternoclavicular joint infection with osteomyelitis, large abscesses, and mediastinitis caused by methicillin-sensitive Staphylococcus aureus.
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Delayed Diagnosis of Pediatric Sternoclavicular Joint Infections and Clavicular Osteomyelitis During the COVID-19 Pandemic: A Report of 3 Cases. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00011. [PMID: 36166203 PMCID: PMC9519139 DOI: 10.5435/jaaosglobal-d-21-00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
Sternoclavicular joint infections and osteomyelitis of the clavicle are extremely rare infections, especially in the pediatric population. Early signs of these infections are nonspecific and can be mistaken for common upper respiratory infections such as COVID-19 and influenza. Rapid diagnosis and treatment are critical for preventing potentially fatal complications such as mediastinitis. We present three cases of sternoclavicular joint infections in the past year during the COVID-19 pandemic. All three patients had delayed diagnoses likely secondary to COVID-19 workup. Each patient underwent surgical irrigation and débridement. Two of three patients required multiple surgeries and prolonged antibiotic courses. Placement of antibiotic-impregnated calcium sulfate beads into the surgical site cleared the infection in all cases where they were used. All three patients made a full recovery; however, the severity of their situations should not be overlooked. Children presenting to the hospital with chest pain, fever, and shortness of breath should not simply be discharged based on a negative COVID-19 test or other viral assays. A higher index of suspicion for bacterial infections such as clavicular osteomyelitis is important. Close attention must be placed on the physical examination to locate potential areas of concentrated pain, erythema, or swelling to prompt advanced imaging if necessary.
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Alhariri S, Kalas MA, Hassan M, Carter JT, Ghafouri SR, Dihowm F. Medical Management of Septic Arthritis of the Sternoclavicular Joint With Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report. Cureus 2022; 14:e23969. [PMID: 35547421 PMCID: PMC9088884 DOI: 10.7759/cureus.23969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/05/2022] Open
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Gonçalves RB, Grenho A, Correia J, Reis JE. Sternoclavicular joint septic arthritis in a healthy adult: a rare diagnosis with frequent complications. J Bone Jt Infect 2021; 6:389-392. [PMID: 34745846 PMCID: PMC8567852 DOI: 10.5194/jbji-6-389-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/21/2021] [Indexed: 11/11/2022] Open
Abstract
We report a case of complicated sternoclavicular joint septic arthritis in a previously healthy adult with no risk factors. An 83-year-old female presented to the emergency with a 1-week history of right shoulder pain followed by fever and prostration in the last 48 h. Computed tomography (CT) scan findings were consistent with right sternoclavicular joint (SCJ) septic arthritis complicated by periarticular abscess. Emergent surgical debridement was performed by a surgical team composed of orthopaedic and thoracic surgeons, followed by 6 weeks of antibiotic treatment. This case highlights the diagnosis and surgical treatment of a rare septic arthritis location but with frequent complications as well as the importance of multidisciplinary collaboration.
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Affiliation(s)
- Rui Barbeiro Gonçalves
- Orthopaedics and Trauma Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - André Grenho
- Orthopaedics and Trauma Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Correia
- Orthopaedics and Trauma Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Eurico Reis
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Reid R, McKnight RR, Secrist E, Clark C. Sternoclavicular Septic Arthritis Caused by Cutibacterium acnes in a Previously Healthy 13-Year-Old Male: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00024. [PMID: 34264874 DOI: 10.2106/jbjs.cc.20.00690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 13-year-old boy presented with 3 weeks of atraumatic left-sided sternoclavicular (SC) joint pain, swelling, and decreased range of motion. After imaging and laboratory workup, he underwent operative irrigation, debridement, and antibiotic therapy with complete resolution of his symptoms. Surgical cultures were consistent with SC septic arthritis. CONCLUSION The management of septic arthritis in pediatric patients remains varied. Here, we present the only report of SC septic arthritis due to Cutibacterium acnes in a healthy pediatric patient. Given the similar clinical findings of pain and swelling to affected bones and joints, differentiating SC septic arthritis from other conditions within the clinical spectrum of chronic nonbacterial osteomyelitis remains challenging. Clinicians should maintain a high index of suspicion when patients present with pain and swelling over the SC joint.
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Affiliation(s)
- Risa Reid
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - Eric Secrist
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - Christian Clark
- Orthocarolina Pediatric Orthopaedic Center, Charlotte, North Carolina
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11
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White-Dzuro CG, Assi PE, Thomas HC, Thayer WP. Unusual presentation of empyema necessitans: case report and review of the literature. Gen Thorac Cardiovasc Surg 2021; 69:1026-1030. [PMID: 33559044 DOI: 10.1007/s11748-021-01601-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
Empyema necessitans is characterized by the extension of a pleural empyema into adjacent structures beyond the pleural space. Although rare, it adds significant complications to patients already suffering from pleural empyema. Standard of surgical care has yet to be characterized or described in the literature. Here, we describe the unusual presentation of a 55-year-old man with methicillin-sensitive Staphylococcus aureus empyema necessitans and outline both our surgical intervention and thoracic reconstruction. We present our case's presentation, management, and outcome. We then review the literature and describe a multidisciplinary approach for management. Empyema necessitans is a very rare and morbid condition requiring urgent intervention to promote optimal outcomes.
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Affiliation(s)
- Colin G White-Dzuro
- Vanderbilt University School of Medicine, Nashville, TN, USA. .,Department of Plastic Surgery, Vanderbilt University Medical Center, D-4207 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37212, USA.
| | - Patrick E Assi
- Department of Plastic Surgery, Vanderbilt University Medical Center, D-4207 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37212, USA
| | | | - Wesley P Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, D-4207 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37212, USA
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Wako Y, Sakamoto M, Rokkaku T, Motegi H, Watanabe H, Yamada T, Yamaguchi T, Inagaki K, Maruyama J, Ueta T. A case of hip joint septic arthritis due to haematogenous infection, which was misdiagnosed sternoclavicular joint septic arthritis as SAPHO syndrome. Mod Rheumatol Case Rep 2021; 5:409-413. [PMID: 33427583 DOI: 10.1080/24725625.2020.1869510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anterior chest pain associated with sternoclavicular arthritis has been considered a symptom specific to SAPHO syndrome. Differentiating aseptic arthritis of the SAPHO syndrome from infectious sternoclavicular joint (SCJ) arthritis is often difficult. We reported a 55-year-old woman with left hip joint and right SCJ pain. Diagnosis and treatment were delayed because she was misdiagnosed with SAPHO syndrome, and haematogenous infection spread to the hip joint septic arthritis. She was diagnosed promptly after presenting to our hospital and underwent early debridement, and her hip joint and SCJ was found to have almost no dysfunction. Differentiation between sternoclavicular arthritis of the SAPHO syndrome and sternoclavicular septic arthritis is clinically important and requires careful attention.
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Affiliation(s)
- Yasushi Wako
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Masaaki Sakamoto
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Tomoyuki Rokkaku
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Hiroyuki Motegi
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Hitoshi Watanabe
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Toshiyuki Yamada
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Takeshi Yamaguchi
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Kenta Inagaki
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Juntaro Maruyama
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Toru Ueta
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
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Abstract
RATIONALE Sternoclavicular joint septic arthritis is an unusual disease in healthy adults, and Staphylococcus aureus is the most common causative pathogen. The current treatment of choice is surgery with sternoclavicular joint resection and pectoralis flap closure, especially when the disease is complicated by osteomyelitis and abscess. PATIENT CONCERNS Here, we report a 76-year-old woman without risk factors who visited our hospital for pain and redness, swelling on the left anterior chest wall. DIAGNOSIS Magnetic resonance imaging showed infectious arthritis in the left SCJ, with multiple abscess pockets at the subcutaneous layer of anterior chest wall communicating with the joint cavity. Streptococcus agalactiae was isolated from blood culture. INTERVENTION She was treated with 6 weeks of antibiotic therapy. OUTCOMES After antibiotic treatment, she was successfully treated without recurrence. LESSONS Besides surgery, medical treatment should also be considered for sternoclavicular joint septic arthritis, depending on patient status and the causative pathogen. Physicians should be aware of this rare disease to facilitate its prompt diagnosis and management.
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A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis. Arch Plast Surg 2020; 47:460-466. [PMID: 32971598 PMCID: PMC7520252 DOI: 10.5999/aps.2020.00717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022] Open
Abstract
Background Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction. Methods A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed. Results Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/m2. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed twostaged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/m2 vs. 32.9±9.1 kg/m2; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01). Conclusions Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a single-stage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay.
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Tasnim S, Shirafkan A, Okereke I. Diagnosis and management of sternoclavicular joint infections: a literature review. J Thorac Dis 2020; 12:4418-4426. [PMID: 32944355 PMCID: PMC7475584 DOI: 10.21037/jtd-20-761] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.
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Affiliation(s)
- Sadia Tasnim
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ali Shirafkan
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
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16
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Fornwalt BE, Goosmann M, Reynolds S, Bunevich JD. Sternoclavicular joint septic arthritis presenting as cervical abscess and subcutaneous emphysema: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20902874. [PMID: 32110404 PMCID: PMC7000855 DOI: 10.1177/2050313x20902874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/31/2019] [Indexed: 11/23/2022] Open
Abstract
Sternoclavicular joint septic arthritis results from hematogenous spread of a
bacterial infection, usually in the immunocompromised. It commonly presents as a
chest wall abscess. Cervical abscess resulting from sternoclavicular joint
septic arthritis is a rare complication with only one reported case in the
English literature. We describe a case of sternoclavicular joint septic
arthritis in an elderly diabetic adult with cervical abscess as initial
presentation.
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Affiliation(s)
- Brandon E Fornwalt
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
| | | | - Stephen Reynolds
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
| | - Jared D Bunevich
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
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Kawashiri SY, Edo Y, Kawakami A. Early Detection of Inflammation and Joint Destruction Revealed by Ultrasound in a Patient with Sternoclavicular Septic Arthritis. Intern Med 2019; 58:865-869. [PMID: 30449803 PMCID: PMC6465004 DOI: 10.2169/internalmedicine.1782-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 53-year-old Japanese man experienced fever/neck pain, and neck magnetic resonance imaging revealed a spinal epidural abscess. The following day, he developed a palpable mass with evident inflammatory signs in the right sternoclavicular joint (SCJ) with severe pain. Ultrasound revealed synovitis with remarkable power Doppler signals in the right SCJ. Blood cultures yielded Streptococcus agalactiae growth. After 12 days, ultrasound showed right distal clavicle bone erosion. His symptoms improved with long-term parenteral antibiotic treatment, but the right SCJ joint destruction progressed for several months. We diagnosed him with sternoclavicular septic arthritis complicated with a spinal epidural abscess and bacteremia.
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Affiliation(s)
- Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yushiro Edo
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Kang BS, Shim HS, Kwon WJ, Lim S, Park GM, Lee TY, Bang M. MRI findings for unilateral sternoclavicular arthritis: differentiation between infectious arthritis and spondyloarthritis. Skeletal Radiol 2019; 48:259-266. [PMID: 29978244 DOI: 10.1007/s00256-018-3023-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To analyze and identify magnetic resonance imaging (MRI) and clinical findings for the differentiation between infectious arthritis and spondyloarthritis in patients with unilateral sternoclavicular arthritis. MATERIALS AND METHODS We retrospectively collected and evaluated the magnetic resonance (MR) images of 21 patients diagnosed with unilateral sternoclavicular arthritis, including 12 with infection and nine with spondyloarthritis, between 2004 and 2017. Capsular distension, extracapsular fluid collection, periarticular muscle edema, the prevalence and distribution of bone marrow edema, and the prevalence and size of bone erosions were assessed on the MR images. Clinical data were also reviewed. RESULTS Capsular distension was more prominent in patients with infectious arthritis than those with spondyloarthritis (p = 0.002); extracapsular fluid collection and periarticular muscle edema were also more common in infectious arthritis than spondyloarthritis (p < 0.001, respectively); moreover, bone erosions were larger in infectious arthritis than spondyloarthritis (p = 0.023). Other findings significantly associated with infectious arthritis included advanced age (p = 0.007), an elevated C-reactive protein (CRP) level (p = 0.001), and erythrocyte sedimentation rate (ESR) (p < 0.001). The prevalence and distribution of bone marrow edema and the prevalence of bone erosions on MRI, the white blood cell count, and sex showed no significant differences between the two groups. CONCLUSIONS Capsular distension, extracapsular fluid collection, periarticular muscle edema, and the size of bone erosions on MRI, as well as the age, CRP level, and ESR of patients, could be helpful for differentiating infectious arthritis from spondyloarthritis involving the sternoclavicular joint.
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Affiliation(s)
- Byeong Seong Kang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea.
| | - Hyun Seok Shim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Woon Jung Kwon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Soyeoun Lim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Gyeong Min Park
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Tae Young Lee
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Minseo Bang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
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Sharif KF, Baik FM, Jategaonkar AA, Khorsandi AS, Urken ML. Septic arthritis of the sternoclavicular joint: A unique late complication after tracheostomy. Am J Otolaryngol 2018; 39:646-648. [PMID: 29776683 DOI: 10.1016/j.amjoto.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Septic arthritis of the sternoclavicular joint is a rare infection associated with significant morbidity and mortality. Several risk factors for septic arthritis have been reported in the literature ranging from immunodeficiency to intravenous drug use. CASE PRESENTATION A 63-year-old male previously treated for synchronous squamous cell carcinomas of the epiglottis and floor of mouth presented with tenderness and swelling of the sternoclavicular joint two months after tracheostomy decannulation. Computed tomography and bone scans confirmed the diagnosis of septic arthritis of the sternoclavicular joint. The patient's clinical course, surgical treatment, and management considerations are discussed here. CONCLUSION Septic arthritis of the SCJ is a rare but serious infection. Once diagnosed, septic arthritis of the SCJ should be promptly treated to prevent further morbidity and mortality.
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McAninch SA, Smithson C, Juergens AL, Collins JN, Nanda A. Sternoclavicular Joint Infection Presenting as Nonspecific Chest Pain. J Emerg Med 2017; 54:229-231. [PMID: 29249550 DOI: 10.1016/j.jemermed.2017.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/20/2017] [Accepted: 11/18/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sternoclavicular joint infection (SJI), to include septic arthritis (SA), is a rare cause of chest pain and is often found in patients with significant risk factors and sources for SA. Most acute care laboratory results lack significant sensitivity to rule out SA. Radiographic findings in common acute care imaging often does not reveal findings of SA and osteomyelitis in the acute phase of the infection. CASE REPORT We present a patient without significant risk factors for SA, who initially presented with 3 days of pain to the left chest, left neck and shoulder. He had fever and was treated with a short course of antibiotics for possible pneumonia. His symptoms recurred along with fever 36 days after the initial onset of symptoms and was then diagnosed radiographically with left-sided SJI. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case reinforces the need to maintain a broad differential diagnosis in the evaluation for chest pain and pursue advanced imaging, such as magnetic resonance imaging, when the pretest probability of SJI is high, especially in the acute phase of the infection.
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Affiliation(s)
- Scott A McAninch
- Department of Emergency Medicine, Scott and White Medical Center - Temple, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Clinton Smithson
- Department of Emergency Medicine, Scott and White Medical Center - Temple, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Andrew L Juergens
- Department of Emergency Medicine, Scott and White Medical Center - Temple, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Jason N Collins
- Department of Emergency Medicine, Scott and White Medical Center - Temple, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Amrita Nanda
- Department of Emergency Medicine, Scott and White Medical Center - Temple, Texas A&M Health Science Center College of Medicine, Temple, Texas
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